Background: The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine.Aim: To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP).Methods: Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI) ≤ 3 on a CT obtained within 48 h of presentation were included.Results: A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p < .05 for all). On multivariable analysis, only persistent SIRS (OR = 3.6, 95% CI 1.4–9.6, p = .01) and an AFC on initial CT (OR = 3.5, 95% CI 1.4–9, p = .009) were independently associated with obtaining >1 CT.Conclusion: An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.
Objective Several factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs). Design We performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses. Results Clinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress. Conclusion Pain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management. Trial registration number The study was registered with ClinicalTrials.gov ( NCT03434392 ).
Recent studies showed that machine learning can assist to better evaluate the induced pain level(s) on healthy individuals in a controlled environment. However, the role of these methods in clinical settings remained unclear and there is an unmet need to develop machine learning assisted tools in pain. The aim of this paper is to develop an automatic pain level assessment model based on patients' physiologic measures from the Medical Information Mart for Intensive Care (MIMIC III). There were two study phases; 1) pilot study, tested three existing machine learning methods proposed recently for healthy individuals. However, these yield poor performances in MIMIC III patients. 2) group study, a novel congeneric clustering method which divided patients into eleven categories and trained a dedicated model for each one. The clustering effectiveness of the proposed congeneric clustering method by showing the highest classification accuracy of 82.86%.